Profile:
glenfmarshall

This is glenfmarshall's Profile page. Use it to view glenfmarshall's comments, other users' replies to these comments, and comments glenfmarshall has endorsed.

What's Happening Now

March 28, 2013 7:59 pm

We need to detach privacy and security from the health care IT domain and realize that it is cross-cutting. People have varying preferences for information access protection and sharing, with a strong overlap with other domains such as finances, employment, social interactions, and personal communication. It would be ideal if there was a single place for people to state their preferences, with a default of opt-out rather than any assumed opt-in.

March 28, 2013 8:07 pm

We need to have a wider sense of what data is “health information”. For example, current plans seem to exclude dental health, chiropractic, non-medical psychological services, health care modalities for people from non-Western cultures, and personal practices such as exercise, diet, work habits, sleep, or family life. Restricting data to a limited or profession-parochial view limits its utility for patients and may prevent care providers from knowing key facts.

March 28, 2013 8:16 pm

People are often seen as unreliable suppliers of clinically-relevant data about themselves. This needs to be examined and, to the extent it is true, remedied.

For example, clinical vocabulary used by providers is more precise than how patients might speak of their health. How best do we bridge that semantic canyon? Similarly, many people do not understand how to determine when they need urgent care versus self-care or non-urgent care. How do we triage more effectively, involving the patient in the process?

March 28, 2013 10:34 pm

I strongly recommend that ONC engage with HL7 to expand the definition of “health information”. They have already considered much of the data identified in my original comment and have key experts in knowledge vocabulary and data structures who can further the work. Assembling the necessary expertise absent HL7′s help will be difficult, and you’d likely engage the same experts that HL7 has in any case.

I also recommend involving the ISO TC/215 US TAG, as they share expertise with HL7.

March 28, 2013 10:36 pm

People are often seen as unreliable suppliers of clinically-relevant data about themselves. This needs to be examined and, to the extent it is true, remedied.

For example, clinical vocabulary used by providers is more precise than how patients might speak of their health. How best do we bridge that semantic canyon? Similarly, many people do not understand how to determine when they need urgent care versus self-care or non-urgent care. How do we triage more effectively, involving the patient in the process?

March 28, 2013 11:29 pm

As far as the gap between clinical vocabulary and layman’s terms, I recommend that ONC form a task group (under an existing FACA) to identify the gaps and prioritize addressing them. As a specific deliverable from the task group’s efforts, we need a “translator” that renders clinical content readable by laypeople and provides hyperlink references where reliable consumer sources exist, e.h., NIH articles.

I also recommend ONC (or another HHS agency) establish a “hotline” service to help people sort the difference between urgent and non-urgent care, and to direct them to self-help as medically appropriate. After it is up & running, a transition plan to non-government operation would be appropriate. As part of this effort, public health education would be very helpful and help reduce ongoing costs.

March 28, 2013 9:26 pm

Thank you for your comment, glenfmarshall. How can the government help define a wider sense of what data is “health information”?

March 28, 2013 9:25 pm

Hi glenfmarshall. ONC is looking for information on how people supply clinically-relevant data about themselves in this section Patient Generated Health Data. Your comment would be helpful in furthering the discussion there.

March 28, 2013 11:17 pm

Thank you for your comment, glenfmarshall. Do you have any suggestions for how ONC can address those questions?

March 28, 2013 11:47 pm

Thanks for your comment, glenfmarshall. What do others think about the idea of a hyperlinked “translator” tool?

March 27, 2013 6:22 pm

Allow for unidentified anonymous testing, patient visits and reporting. This can be achieved by many means – for example – issuing a single use patient ID number and passcode.

Additionally, one should provide meaningful security that does not allow for private information to leak out – even if your server security (or the patient’s device security) is breached. (The best way to ensure this is to allow for unidentified anonymous reporting, and to explicitly minimize the data regarding the user that is stored when they visit the site.)

March 28, 2013 6:32 am

SUGGESTION – shift the focus away from data and information towards using health IT to strengthen the RELATIONSHIP AND OUTCOMES between everyone on the care team – including patients and their care givers. The “r” in EMR should be “relationship” not “record”

Example: I both worked at and received my care at Group Health Cooperative (owned by its 620,000 patient/members)and we have had an EHR since 2005 and over 60% of all members use it to not only download data like labs but to stay connected to our care team via a patient portal, mobile apps, email etc combined with new roles on the health care team like 24/7 consulting nurses, and workflows that include the patient at the design stage vs after the fact (engagement)

The goal isn’t… more »

…data but tool that allows connection anytime anywhere to the health care team.

PRO’S CON’S
Many people discredit the group health mayo models because they are integrated systems (docs on salary and investments from health IT are kept in house vs going out the door to the insurance co’s) but this works in the “private” sector as well

PERSONAL EXAMPLE -After I left GHC I got my care via the University of Washington (uses the same EHR as Group Health) I once started to get sick a few hours before I had to fly out of town on a business trip. I called the after hours consulting nurse and she pulled up my records, authorized an RX that was sent to a national chain in Boston, when I arrived I picked it up, the next morning my doctor’s office nurse called me up to check on me. The entire event happened on the phone and online and took my needs and workflow into account and the tech enabled it.

DATA OR REFERENCES – Group Health Cooperative started their EHR implementation by giving patients access first to their clincial records and online services and is now one of the top 10 ranked health plans in the US and the top ranked in the region – http://www.ghc.org/news/news.jhtml?reposid=/common/news/news/20120920-quality.html

Critical to their success was using healthIT to identify other areas that needed to change and they also shifted to the medical home model in the last few years. https://www1.ghc.org/html/public/features/20101001-medical-home.html “For every dollar Group Health invested, mostly to boost staffing, it recouped $1.50.”

CONCLUSION HealthIT wasn’t the sole solution but it was a critical foundational component to this change and the benefits are clear both in terms of quality, patient satisfaction and provider retention. It goes way beyond merely sharing information and data and is instead a core backbone of a health care system that meets the six pillars and 3 aims of a learning health care system of the future – foundational to that is patient centered design and care (vs after the fact consumer engagement) « less

March 27, 2013 1:27 pm

I think it would be helpful for ONC to support/commission development of curriculum that addresses communication skills, tools, vignettes from the consumer viewpoint & the provider viewpoint. It is my opinion that seek first to understand is a key/missing component in many provider-patient encounters. Perhaps we all just need a “refresher” on this very fundamental skill?